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E. Blair Holladay, PhD, MASCP, SCT(ASCP)CM
Chief Executive Officer 

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Our Recent Articles

Laboratory Supply Chain Shortage Effects on Laboratory Workforce and Effective Test Utilization

May 10, 2022, 10:22 AM by Lee Hilborne, Edna Garcia, and Iman Kundu

Recently, members of the ASCP’s Effective Test Utilization Committee released an American Journal of Clinical Pathology (AJCP) editorial addressing laboratory supply shortages and how these issues have created “a health care crisis, including for the practice of laboratory medicine.”1  The editorial, Laboratory Supply Shortages: Turning Crisis to Opportunity, provided strategies for laboratories to help mitigate this issue while “delivering quality patient care that improves clinical outcomes and patient satisfaction.”1 

To help understand and quantify the scope of supply chain issues in the laboratory, we surveyed both the ASCP Choosing Wisely Advisory Board and ASCP membership. We asked the participants about the impact of supply chain issues on their laboratory, the initiatives they undertook to address them, and any suggestions to reduce unnecessary supply consumption. 

Qualitative analysis of the survey responses shows nationally that the laboratory supply shortages affected not only the timely acquisition of laboratory reagents and supplies, but also the job satisfaction and well-being of laboratory personnel. According to survey respondents, the laboratory materials most commonly in short supply include blood collection tubes, reagents, needles, pipette tips, syringes, media, COVID-19 test kits and personal protective equipment (PPE) (Table 1).  Respondents also indicated that supply chain issues consume critical time at the expense of rendering diagnoses. Many participants reported that when using alternative supplies or methods (Table 1), they “scramble to do validations and procedure changes and training on the fly,” which leads to reporting delays. Staff time becomes divided between validating alternative supplies and performing testing. This disrupts workflow, leading to stress and burnout (Table 1). Outsourcing tests to reference laboratories and borrowing supplies from other hospitals were common due to insufficient laboratory materials to complete tests on time (Table 1).   

Table 1. Impact of supply chain issues in the laboratory 

 

Themes

Count

Percent

Laboratory supply shortage

88

63.8%

Taking away critical time from diagnosing cases

53

38.4%

Utilize alternative methods, vendors or supplies

36

26.1%

Outsourcing

18

13.0%

Stress and burnout

12

8.7%

Total

138

100.0%

 

Due to the impact of supply chain issues in the laboratory, survey respondents undertook several measures to alleviate effects on laboratory operations (Table 2). Employing alternative test supplies (e.g., switch to serum separator tubes when lithium heparin tubes were unavailable, use different collection tube size, use different series of slides) was the most common strategy. Other strategies included changing suppliers and borrowing or loaning supplies from other laboratories, within or outside the hospital system. In some cases, the respondents reported sending tests to reference laboratories.  

The second most common initiative was testing conservation strategies, including decreasing extra tube draws, stopping rainbow draws in emergency departments, and identifying ways to conserve reagents. Efforts also included changing ordering practices (e.g., stopping physicians from placing daily morning or other recurrent laboratory draws) and encouraging effective test utilization. Other initiatives included ordering supplies in advance, closer inventory monitoring and continuous external (e.g., vendor) and internal (e.g., providers and hospital administration) communication about the supply chain shortage issue. 

Table 2. Initiatives to address supply chain issues 

 

Themes

Count

Percent

Using alternative test supplies/vendors/labs

73

55.3%

Testing conservation strategies

47

35.6%

Ordering additional supplies

21

15.9%

Continuing communication with vendor

10

7.6%

Educate providers

10

7.6%

Monitor inventory

9

6.8%

Not in charge

5

3.8%

Communication with hospital administration

3

2.3%

Miscellaneous

14

10.6%

Total

132

100.0%

 

To reduce unnecessary supply consumption, survey respondents suggested developing test utilization strategies and encouraging education and awareness for the entire laboratory community on better ordering practices (Table 3). The most common test utilization strategies suggested include expanding “Choosing Wisely” best practices,1,2 limiting unnecessary and frequent testing, eliminating tests that lack clinical utility, advocating for federal government reevaluation of policies and regulations on test ordering, linking physician reimbursement for office visits with following medical necessity guidelines, and using laboratory stewardship to ensure the right tests are ordered for the right patient at the right time. Responders acknowledged the value of seeking staff ideas and involvement to promote best practices and dialogue. 

Education and awareness are key to impactful promotion of effective test utilization. Key educational opportunities include: 

  • Laboratory stewardship generally and awareness of all stakeholders including researchers and providers on test ordering 

  • Exploring opportunities with physicians to reduce unnecessary testing 

  • Prioritizing urgent tests for patient care 

  • Providing guidelines for the new staff trainees 

  • Developing or improving communication between shifts to prevent duplicate testing 

  • Developing a national or international communication line to align those with shortages and those with surplus to help prevent waste. 

Respondents recommended working with manufacturers to evaluate opportunities to extend reagent life and consolidating orders to better streamline the workflow. Knowing reagent and supply status through more frequent inventory, advance ordering (e.g., allowing an extra three to four weeks), exploring re-usable alternatives to disposable items and understanding alternative supply sources when surge demand exists can all ease strains during times of stress, Table 3. 

Table 3. Suggestions to reduce unnecessary supply consumption 

 

Themes

Count

Percent

Develop test utilization strategies

49

39.5%

Education/Awareness

25

20.2%

Other

34

27.4%

Total

124

100.0%

 

The initiatives laboratories implemented to address the 2020-2022 laboratory supply chain issues and the suggestions presented by the survey respondents have short term gains by easing the shortages but will also promote appropriate and necessary quality patient care. There is also an urgent need for recommendations to address laboratory personnel well-being, especially the stress and burnout they are experiencing due to increased workload and other pressures. According to the report, The Clinical Laboratory Workforce: Understanding the Challenges to Meeting Current and Future Needs,3 “the pandemic heightened awareness and urgency about the need to address staffing challenges that laboratories have long experienced, as well as identifying strategies to address work-life balance challenges and burnout among laboratory professionals.”3 Further, the COVID-19 pandemic disrupted the laboratory workforce and may accelerate future shortages in clinical laboratory medicine. 

Results from this survey provide a springboard for broader engagement, including sponsoring forums that focus on supply chain issues and the role of laboratory stewardship/Choosing Wisely. These interactions should promote solutions-based discussions and advocacy efforts. This is particularly relevant now as the value of laboratory medicine has new stature in response to the COVID-19 pandemic.   

References 

1. Hilborne L, Sossaman G, Caldwell B, Kroft S. Laboratory Supply Shortages. American Journal of Clinical Pathology. https://academic.oup.com/ajcp/advance-article/doi/10.1093/ajcp/aqac035/6539925. Published 2022. Accessed April 27, 2022.
2. Thirty-Five Things Physicians and Patients Should Question. Ascp.org. https://www.ascp.org/content/docs/default-source/get-involved-pdfs/istp_choosingwisely/ascp-35-things-list_2020_final.pdf. Published 2022. Accessed April 28, 2022.
3. Garcia E, Kundu I, Kelly M, Guenther G, Skillman SM, Frogner B. The Clinical Laboratory Workforce: Understanding the Challenges to Meeting Current and Future Needs. American Society for Clinical Pathology (Washington, DC) and Center for Health Workforce Studies, University of Washington (Seattle, WA), April 2021. https://ascpcdn.s3.amazonaws.com/static/ISTP/ASCP_UW_Clinical+Laboratory+Workforce_Report_2021.pdf. Accessed April 28, 2022.